Ultra-processed food intake is associated with children and adolescents with congenital heart disease clustered by high cardiovascular risk factors.

The excessive intake of ultra-processed foods (UPF) is associated with an increase in cardiovascular risk. However, the effect of UPF intake on cardiovascular health in children and adolescents with congenital heart disease (CHD) is unknown. The aim of the present study was to describe UPF intake and evaluate associations with isolated cardiovascular risk factors and children and adolescents with CHD clustered by cardiovascular risk factors. A cross-sectional study was conducted involving 232 children and adolescents with CHD. Dietary intake was assessed using three 24-hour recalls. UPFs were categorized using the NOVA classification. The cardiovascular risk factors evaluated were central adiposity, elevated high-sensitivity C-reactive protein (hs-CRP) and subclinical atherosclerosis. The clustering of cardiovascular risk factors (waist circumference, hs-CRP and carotid intima-media thickness) was performed, allocating the participants to two groups (high versus low cardiovascular risk). UPFs contributed 40.69% (SD 6.21) to total energy intake. The main UPF groups were ready-to-eat and take-away/fast foods (22.2% energy from UPFs). The multivariable logistic regression revealed that an absolute increase of 10% in UPF intake (OR=1.90; 95% CI: 1.01;3.58) was associated with central adiposity. An absolute increase of 10% in UPF intake (OR=3.77; 95% CI: 1.80;7.87) was also associated with children and adolescents with CHD clustered by high cardiovascular risk after adjusting for confounding factors. Our findings demonstrate that UPF intake should be considered a modifiable risk factor for obesity and its cardiovascular consequences in children and adolescents with CHD.

Aerobic fitness and physical activity are inversely associated with body fat, dyslipidemia and inflammatory mediators in children and adolescents living with HIV.

This study aimed to investigate if moderate to vigorous physical activity (MVPA) and aerobic fitness are associated with cardiovascular risk factors in HIV+ children and adolescents. Sixty-five children and adolescents (8 to 15 years) provided minutes of MVPA measured by accelerometers and peak oxygen uptake (peak VO2) by breath-by-breath respiratory exchange. Cardiovascular risk factors were characterized by body fat, blood pressure, total cholesterol, HDL-c, LDL-c, triglycerides, glucose, insulin, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α) and carotid intima-media thickness. Results indicated that higher MVPA was associated with lower values of total (ß =  -3.566) and trunk body fat (ß = -3.495), total cholesterol (ß = -0.112) and LDL-c (ß = -0.830). Likewise, higher peak VO2 was associated with lower total (ß = -0.629) and trunk body fat values (ß = -0.592) and levels of CRP (ß = -0.059). The physically active participants had lower total cholesterol (-24.4 mg.dL-1) and LDL-c (-20.1 mg.dL-1) compared to participants judged to be insufficiently active. Moreover, participants with satisfactory peak VO2 showed lower total (-4.1%) and trunk (-4.3%) body fat, CRP (-2.3 mg.L-1), IL-6 (-2.4 pg.mL-1) and TNF-α (-1.0 pg.mL-1) compared to low peak VO2 peers. High levels of MVPA and aerobic fitness may prevent developing of cardiovascular risk factors in children and adolescents HIV+.

Prediction of Areal Bone Mineral Density and Bone Mineral Content in Children and Adolescents Living With HIV Based on Anthropometric Variables.

Children and adolescents living with HIV have low bone mass for age. There are reliable and accurate methods for evaluation of bone mass, however, alternative methods are necessary, especially, for application in limited-resource scenarios. Anthropometry is a noninvasive and low cost method that can predict bone mass in healthy youths. The aim of the study was to develop predictive equations for bone mineral content and bone mineral density in children and adolescents living with HIV based on anthropometric variables. Forty-eight children and adolescents of both sexes (24 females) from 7 to 17 years, living in greater Florianopolis area, Santa Catarina, Brazil, who were under clinical follow-up at "Hospital Infantil Joana de Gusmão", participated in the study. Dual-energy X-ray absorptiometry was used to evaluate whole-body bone mineral content (BMC) and areal bone mineral density (aBMD). Height, body weight, bone diameters, arm circumference, and triceps skinfold were measured and the body mass index and arm muscle area were calculated. Multiple regression models were fitted to predict BMC and aBMD, using backward selection (p ≥ 0.05). Two predictive models with high R2 values (84%-94%) were developed. Model 1 to estimate aBMD [Y = -0.1450124 + (height × 0.0033807) + (age × 0.0146381) + (body mass index × 0.0158838) + (skin color × 0.0421068)], and model 2 to estimate BMC [Y = 1095.1 + (body weight × 45.66973) + (age × 31.36516) + (arm circumference × -53.27204) + (femoral diameter × -9.594018)].The predictive models using anthropometry provided reliable estimates and can be useful to monitor aBMD and BMC in children and adolescents living with human immunodeficiency virus where limited resources are available.

Consumption and Breakfast Patterns in Children and Adolescents with Congenital Heart Disease.

Little is known about skipping breakfast and breakfast patterns (BP) and their evaluation according to sociodemographic, clinical, lifestyle, cardiometabolic and nutritional data in children and adolescents with congenital heart disease (CHD). This cross-sectional study with 232 children and adolescents with CHD identified the prevalence and patterns of the breakfast, described these according to sociodemographic, clinical and lifestyle characteristics, and assessed their association with cardiometabolic and nutritional markers. Breakfast patterns were identified by principal components, and bivariate and linear regression analysis were applied. Breakfast consumption was observed in 73% of participants. Four BP were identified: pattern 1 "milk, ultra-processed bread, and chocolate milk", pattern 2 "margarine and processed bread", pattern 3 "cold meats/sausages, cheeses and butter/cream" and pattern 4 "fruits/fruit juices, breakfast cereals, yogurts, and homemade cakes/pies and sweet snacks". Family history for obesity and acyanotic CHD were associated with breakfast skipping. Younger participants and greater maternal education were associated with greater adherence to pattern 1 and pattern 4. Older participants and longer post-operative time showed greater adherence to pattern 3. No association between skipping breakfast or BP and cardiometabolic and nutritional markers was observed. Nonetheless, the findings reinforce the need for nutritional guidance for healthy breakfast, aiming to reduce the consumption of ultra-processed foods and to prioritize fresh and minimally processed foods.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease.

OBJECTIVE: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. METHODS: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. RESULTS: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). CONCLUSIONS: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health.

OBJECTIVES: To discuss the associations between habits and environment in childhood and cardiovascular effects on adults. SOURCE OF DATA: Search in PubMed, Scielo and Science databases, cohort or case-control studies, and systematic or scope-based reviewson the causal relationship among exposures in the pediatric age group and cardiovascular effects in adults. SYNTHESIS OF DATA: The authors identified 41 eligible articles, which demonstrated an impact on cardiovascular health (characterized as surrogate events - structural or functional vascular alterations or left ventricular dysfunction - or clinical events - myocardial infarction, stroke or cardiovascular death) with environmental aspects (intrauterine or economically poor environment, violence, reduced life expectancy and serious infections) and habits (nutrition, physical activity and tobacco exposure). In addition to the direct and independent associations between exposures and outcomes, several traditional cardiovascular risk factors (CVRF) or family histories are also intermediate pathophysiological pathways in the described phenomena. CONCLUSIONS: There are direct relationships between lifestyle and inadequate environments in childhood and cardiovascular effects, although the observed associations showed divergences in terms of results and interpretation. In spite of these, it is recommended to encourage healthy lifestyles and protection against childhood adverse exposures, as habit formation occurs at this age, and its relationship with CVRF since childhood has already been well established. On the other hand, the format and intensity of the stimulus must respect the social, cultural and psychological aspects of each population, aiming to obtain the best and most lasting result without generating harmful consequences for the individuals.

Compound Heterozygous Familial Hypercholesterolemia Caused by LDLR Variants. / Portador Heterozigoto Composto de Hipercolesterolemia Familiar Causada por Variantes no LDLR.

Familial hypercholesterolemia (FH) is a genetic disease caused by a primary defect in the LDL-receptor gene. Distinct variants in the same gene characterize a compound heterozygote, but little is known about the phenotypes of the carriers. Therefore, herein, we describe the cascade screening of a Brazilian family with this characteristic. The index case, a 36-year-old male, had a total cholesterol level of 360 mg/dL (9.3 mmol/L) and LDL-c value of 259 mg/dL (6.7 mmol/L), in addition to Achilles tendon xanthomas, obesity and prehypertension. Genotyping identified the variants 661G>A, 670G>A, 682G>A in exon 4 and 919G>A in exon 6. The same variant in exon 4 was found in the index case's son (7-y), who also had hypercholesterolemia and xanthomas, while the index case's daughter (9-y) had the variant in exon 6 and hyperlipidemia, without xanthomas. In summary, this report allows for a better insight into the molecular basis of FH in Brazil, a multi-racial country where a heterogeneous population is expected.

A hipercolesterolemia familiar (HF) é uma doença genética causada por um defeito primário no gene que codifica o receptor da LDL. Mutações diferentes no mesmo gene caracterizam um heterozigoto composto, mas pouco se sabe sobre o fenótipo dos portadores. Portanto, neste estudo, descrevemos o rastreamento em cascata de uma família brasileira com essa característica. O caso-índice é um homem de 36 anos, com colesterol total (CT) de 360 mg/dL (9,3 mmol/L) e concentração de LDL-c de 259 mg/dL (6,7 mmol/L), além de xantomas de tendão de Aquiles, obesidade e pré-hipertensão. A genotipagem identificou as mutações 661G>A, 670G>A e 682G>A, no exon 4, e 919G>A, no exon 6. A mesma mutação no exon 4 foi observada no filho do caso-índice (7 anos), que também tem hipercolesterolemia e xantomas tendinosos, ao passo que a filha do caso-índice (9 anos) apresenta mutação no exon 6 e hiperlipidemia, sem xantomas. Em suma, este relato permite uma melhor compreensão acerca da base molecular da HF no Brasil, um país multirracial, onde é esperada uma população heterogênea.

Level of leisure-time physical activity and its association with the prevalence of metabolic syndrome in adults: a population-based study. / Nível de atividade física de lazer e sua associação com a prevalência de síndrome metabólica em adultos: estudo de base populacional.

OBJECTIVE: To analyze the associations between changes in the level of leisure-time physical activity in adults and the prevalence of metabolic syndrome. METHODS: This is a population-based study conducted with 818 adults aged 20 years or older from Florianópolis, Santa Catarina, Southern Brazil, between 2009 and 2014. We tested the association of maintenance and/or changes in the level of physical activity with the prevalence of metabolic syndrome, adjusted for sociodemographic variables (gender, age, schooling, income, marital status, and ethnicity) and smoking habits. We used logistic regression and estimated the odds ratios (OR) and their respective confidence intervals (95%CI). RESULTS: The overall prevalence of metabolic syndrome was 30.9% (95%CI 27.2-34.7). Regardless of adjustment variables, adults who ceased to be active and/or remained physically inactive during leisure time in the study period presented, respectively, 108 and 124% higher odds of developing metabolic syndrome (OR=2.08; 95%CI 1.30-3.33 and OR=2.24; 95%CI 1.38-3.65). Women and individuals younger than 45 years showed lower odds of having metabolic syndrome. CONCLUSIONS: This sample presented a significant association between remaining or becoming inactive and a greater chance of developing metabolic syndrome.

Sexual violence against children: authors, victims and consequences. / Violência sexual contra crianças: autores, vítimas e consequências.

The scope of this study was to identify the characteristics of sexual abuse against children including the profiles of the victims and the perpetrators, and associated factors notified in a health service of reference with the database of the Brazilian Case Registry Database, in a city in the south of Brazil. Categorical variables are presented in prevalence with 95% confidence intervals. There were 489 notifications from 2008 to 2014 of confirmed or suspected child sexual abuse. The majority was related to female victims, but the repeated abuse was reported mainly with male victims. In most cases, the abuse took place at the victims' or perpetrators' homes and the main perpetrators of abuse were male and acquainted with the victims. Twelve victims have contracted sexually transmitted infections; pregnancies were six, five of them legally terminated. This study highlights that the child sexual abuse profiles were similar in almost all of Brazilian regions, showing that it is possible to have a coordinated national action to prevent this offence.

Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study.

HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (ß = 0.006, p = 0.004) and TNF-α (ß = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (ß = -0.186, p = 0.008), trunk body fat (ß = -0.011, p = 0.006), glucose (ß = 0.005, p = 0.046), and IL-6 (ß = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease / Mudanças nos comportamentos de estilo de vida durante a pandemia COVID-19 em crianças e adolescentes com cardiopatia congênita

Abstract Objective: To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes. Methods: Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior. Results: The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90). Conclusions: Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Resumo Objetivo: Descrever as mudanças nos estilos de vida durante a pandemia em crianças e adolescentes com cardiopatia congênita e investigar a associação da complexidade da cardiopatia congênita com as mudanças de estilo de vida. Métodos: Estudo transversal com 127 crianças e adolescentes com cardiopatia congênita, que realizaram procedimento cardíaco (tempo médio de pós-operatório: 10,11 (3,13) anos), realizado entre dezembro de 2020 e janeiro de 2021. O estilo de vida (alimentação, atividade física, comportamento sedentário e sono) foi avaliado por entrevista telefônica, com base em questionários validados. Padrões alimentares foram identificados por meio da análise de componentes principais. Frequência de combinações gerais e específicas de mudanças de estilo de vida saudável e não saudável foram avaliadas. Regressões logísticas multinominais foram utilizadas para testar associações. Resultados: Os principais comportamentos de estilo de vida adquiridos durante a pandemia foram: 83,5% reduziram a atividade física, 37,0% aumentaram o comportamento sedentário, 26,0% dormiram mais e 23,6% mudaram para um padrão alimentar menos saudável. Quase metade (41,8%) dos participantes teve pelo menos uma mudança não saudável no estilo de vida. Cardiopatias congênitas complexas foram associadas ao aumento do comportamento sedentário durante a pandemia (odds ratio 3,49, IC95% 1,23-9,90). Conclusões: Crianças e adolescentes com cardiopatia congênita apresentaram estilo de vida não saudável durante a pandemia, principalmente na forma de redução da atividade física e aumento do comportamento sedentário.

Lifestyle, inadequate environments in childhood and their effects on adult cardiovascular health

Abstract Objectives: To discuss the associations between habits and environment in childhood and cardiovascular effects on adults. Source of data: Search in PubMed, Scielo and Science databases, cohort or case-control studies, and systematic or scope-based reviewson the causal relationship among exposures in the pediatric age group and cardiovascular effects in adults. Synthesis of data: The authors identified 41 eligible articles, which demonstrated an impact on cardiovascular health (characterized as surrogate events - structural or functional vascular alterations or left ventricular dysfunction - or clinical events - myocardial infarction, stroke or cardiovascular death) with environmental aspects (intrauterine or economically poor environment, violence, reduced life expectancy and serious infections) and habits (nutrition, physical activity and tobacco exposure). In addition to the direct and independent associations between exposures and outcomes, several traditional cardiovascular risk factors (CVRF) or family histories are also intermediate pathophysiological pathways in the described phenomena. Conclusions: There are direct relationships between lifestyle and inadequate environments in childhood and cardiovascular effects, although the observed associations showed divergences in terms of results and interpretation. In spite of these, it is recommended to encourage healthy lifestyles and protection against childhood adverse exposures, as habit formation occurs at this age, and its relationship with CVRF since childhood has already been well established. On the other hand, the format and intensity of the stimulus must respect the social, cultural and psychological aspects of each population, aiming to obtain the best and most lasting result without generating harmful consequences for the individuals.

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Abstract Background Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity. Objectives To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease. Methods Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the "undesirable" levels, consisting of the sum of "borderline" and "low" values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant. Results Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c. Conclusion In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

Emergency Department Visits and Deaths from Cardiovascular Diseases at a Referral Center for Cardiology During the COVID-19 Pandemic

Abstract Background The COVID-19 pandemic has imposed measures of social distancing and, during this time, there has been an elevation in cardiovascular mortality rates and a decrease in the number of emergency visits. Objectives To assess and compare in-hospital mortality for cardiovascular diseases and emergency department visits during the COVID-19 pandemic and the same period in 2019. Methods Retrospective, single-center study that evaluated emergency visits and in-hospital deaths between March 16, 2020 and June 16, 2020, when the steepest fall in the number of emergency admissions for COVID-19 was registered. These data were compared with the emergency visits and in-hospital deaths between March 16 and June 16, 2019. We analyzed the total number of deaths, and cardiovascular deaths. The level of significance was set at p < 0.05. Results There was a 35% decrease in the number of emergency visits and an increase in the ratio of the number of deaths to the number of emergency visits in 2020. The increase in the ratio of the number of all-cause deaths to the number of emergency visits was 45.6% and the increase in the ratio of the number of cardiovascular deaths to the number of emergency visits was 62.1%. None of the patients who died in the study period in 2020 tested positive for COVID-19. Conclusion In-hospital mortality for cardiovascular diseases increased proportionally to the number of emergency visits during the COVID-19-imposed social distancing compared with the same period in 2019. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Depression associated variables among lower limb amputees in Santa Catarina State - Brazil / Fatores associados à depressão em pacientes amputados de membros inferiores no Estado de Santa Catarina - Brasil

The amputation of the lower limbs and depression has been studied by different groups with a wide prevalence range and some variables were related to depressive symptoms. Depression and anxiety have been related with a major impact on adherence to rehabilitation, functional prognosis, and quality of life. Knowing the patients at highest odds of presenting depressive symptoms may favor an early approach and treatment, ultimately optimizing the rehabilitation process and social reintegration. Depression can be related to a lower rate of adaptation to the prosthesis and its use. Objective: To determine the association among demographic, socioeconomic, clinical variables with depressive symptoms in amputees before the prosthetic adaptation. Methods: A case-control study was performed to analyze variables associated with depression (Beck Depression Inventory-II) in lower limb amputees. Results: Patients with previous depression (OR= 17,08; CI95:2,14-136,28) and low socioeconomic class (OR= 3,04; CI95:1,24-7,47) are at highest odds of depression after amputation in the state of Santa Catarina. The model explained 71,4% of cases, classifying 88,1% of negative and 23,8% of positive cases. According to our model amputees recruited rarely presented the diagnosis of depression if they belong to a higher socioeconomic class and have no previous depression. On the other hand, patients who presented Brazilian low socioeconomic class D-E, and previous depression should be referenced to a psychological evaluation because they have a chance of depression, close to 1 in 4 cases. Conclusion: Previous depression and low social class were associated with the highest odds of depression after amputation in our population.

Sintomas depressivos em pacientes com amputação de membros inferiores foram foco de diversos estudos, com amplos intervalos de prevalência encontrados, e algumas variáveis foram relacionadas com os sintomas depressivos. Depressão e ansiedade têm grande impacto na aderência à reabilitação, no prognóstico funcional e na qualidade de vida. Conhecer os pacientes que têm maior risco de apresentar sintomas depressivos pode favorecer uma abordagem precoce e seu tratamento, potencializando a reabilitação, a reinserção social, a adaptação à prótese e seu uso. Objetivo: Determinar associação entre fatores demográficos, socioeconômicos, e clínicos com sintomas depressivos em pacientes amputados antes da protetização. Métodos: Estudo tipo caso-controle para avaliar fatores associados - dados demográficos, socioeconômicos e comorbidades - à depressão (utilizando escala de depressão de Beck-II) em pacientes com amputação de membro inferior. Resultados: Pacientes com depressão prévia (OR= 17,08, IC95:2,14-136,28) e baixa classe social (OR= 3,04, IC95:1,24-7,47) apresentam alta chance de depressão após amputação em Santa Catarina. O modelo explica 71.4% dos casos, classificando adequadamente 88,1% dos negativos e 23,8% dos positivos. E encontrou-se maior capacidade de predizer casos negativos - amputados raramente apresentaram diagnóstico de depressão se pertenciam a uma classe social mais alta e se não tinham diagnóstico prévio de depressão. Pacientes de classes sociais D-E, e diagnóstico prévio de depressão devem ser referenciados para avaliação psicológica devido à chance de depressão próxima de 1 a cada 4 casos. Conclusão: Depressão prévia à amputação e classes sociais mais baixas apresentaram maior chance de desenvolver sintomas depressivos após amputação na população estudada.

Portador Heterozigoto Composto de Hipercolesterolemia Familiar Causada por Variantes no LDLR / Compound Heterozygous Familial Hypercholesterolemia Caused by LDLR Variants

Resumo A hipercolesterolemia familiar (HF) é uma doença genética causada por um defeito primário no gene que codifica o receptor da LDL. Mutações diferentes no mesmo gene caracterizam um heterozigoto composto, mas pouco se sabe sobre o fenótipo dos portadores. Portanto, neste estudo, descrevemos o rastreamento em cascata de uma família brasileira com essa característica. O caso-índice é um homem de 36 anos, com colesterol total (CT) de 360 mg/dL (9,3 mmol/L) e concentração de LDL-c de 259 mg/dL (6,7 mmol/L), além de xantomas de tendão de Aquiles, obesidade e pré-hipertensão. A genotipagem identificou as mutações 661G>A, 670G>A e 682G>A, no exon 4, e 919G>A, no exon 6. A mesma mutação no exon 4 foi observada no filho do caso-índice (7 anos), que também tem hipercolesterolemia e xantomas tendinosos, ao passo que a filha do caso-índice (9 anos) apresenta mutação no exon 6 e hiperlipidemia, sem xantomas. Em suma, este relato permite uma melhor compreensão acerca da base molecular da HF no Brasil, um país multirracial, onde é esperada uma população heterogênea.

Abstract Familial hypercholesterolemia (FH) is a genetic disease caused by a primary defect in the LDL-receptor gene. Distinct variants in the same gene characterize a compound heterozygote, but little is known about the phenotypes of the carriers. Therefore, herein, we describe the cascade screening of a Brazilian family with this characteristic. The index case, a 36-year-old male, had a total cholesterol level of 360 mg/dL (9.3 mmol/L) and LDL-c value of 259 mg/dL (6.7 mmol/L), in addition to Achilles tendon xanthomas, obesity and prehypertension. Genotyping identified the variants 661G>A, 670G>A, 682G>A in exon 4 and 919G>A in exon 6. The same variant in exon 4 was found in the index case's son (7-y), who also had hypercholesterolemia and xanthomas, while the index case's daughter (9-y) had the variant in exon 6 and hyperlipidemia, without xanthomas. In summary, this report allows for a better insight into the molecular basis of FH in Brazil, a multi-racial country where a heterogeneous population is expected.

Nível de atividade física de lazer e sua associação com a prevalência de síndrome metabólica em adultos: estudo de base populacional / Level of leisure-time physical activity and its association with the prevalence of metabolic syndrome in adults: a population-based study

RESUMO: Objetivo: Analisar as associações entre mudanças do nível de atividade física de lazer em adultos com a prevalência de síndrome metabólica. Métodos: Estudo de base populacional realizado com 818 adultos de 20 anos ou mais em Florianópolis, Santa Catarina, entre 2009 e 2014. Testou-se a associação da manutenção e/ou mudança do nível de atividade física com a prevalência de síndrome metabólica, ajustada por variáveis sociodemográficas (sexo, idade, escolaridade, renda, estado civil e cor da pele) e tabagismo. Empregou-se regressão logística, estimando-se as razões de chance (OR) e os respectivos intervalos de confiança (IC95%). Resultados: A prevalência geral de síndrome metabólica foi de 30,9% (IC95% 27,2 - 34,7). Independentemente das variáveis de ajuste, os adultos que deixaram de ser ativos e/ou se mantiveram fisicamente inativos no lazer no período apresentaram, respectivamente, 108 e 124% maiores chances para a síndrome metabólica (OR = 2,08; IC95% 1,30 - 3,33) e (OR = 2,24; IC95% 1,38 - 3,65). As mulheres e os indivíduos com idade inferior a 45 anos apresentaram menores chances para a síndrome metabólica. Conclusões: Nesta amostra, manter-se inativo ou passar a sê-lo associou-se, significativamente, com maiores chances para a síndrome metabólica.

ABSTRACT: Objective: To analyze the associations between changes in the level of leisure-time physical activity in adults and the prevalence of metabolic syndrome. Methods: This is a population-based study conducted with 818 adults aged 20 years or older from Florianópolis, Santa Catarina, Southern Brazil, between 2009 and 2014. We tested the association of maintenance and/or changes in the level of physical activity with the prevalence of metabolic syndrome, adjusted for sociodemographic variables (gender, age, schooling, income, marital status, and ethnicity) and smoking habits. We used logistic regression and estimated the odds ratios (OR) and their respective confidence intervals (95%CI). Results: The overall prevalence of metabolic syndrome was 30.9% (95%CI 27.2-34.7). Regardless of adjustment variables, adults who ceased to be active and/or remained physically inactive during leisure time in the study period presented, respectively, 108 and 124% higher odds of developing metabolic syndrome (OR=2.08; 95%CI 1.30-3.33 and OR=2.24; 95%CI 1.38-3.65). Women and individuals younger than 45 years showed lower odds of having metabolic syndrome. Conclusions: This sample presented a significant association between remaining or becoming inactive and a greater chance of developing metabolic syndrome.

Estudo Longitudinal EpiFloripa Idoso - Rotinas de organização e protocolos referentes à coleta, análise e armazenamento de material biológico, exames de imagem e capacidade físico-funcional / EpiFloripa Ageing Longitudinal Study - Organizational routines and protocols related to the collection, analysis and storage of biological material, image exams and physical-functional capacity

Resumo Introdução Exames complementares podem contribuir para a compreensão da etiologia de agravos à saúde de idosos. Objetivo Descrever os aspectos operacionais e protocolos referentes à coleta, análise e armazenamento de material biológico, exames de imagem e capacidade físico-funcional. Método Estudo longitudinal, de base populacional, com 604 idosos (≥ 60 anos) do estudo EpiFloripa Idoso, em 2014. Foram coletados dados de material biológico, composição corporal, densitometria óssea, ultrassonografia da espessura íntima média das artérias carótidas, força de preensão manual e a atividade física. Resultados A taxa de resposta foi de 50,4%. Houve perda de seguimento em relação à faixa etária, estado cognitivo e atividades de vida diária. Os indivíduos que realizaram os exames eram mais novos, trabalhavam no momento da entrevista, ingeriam álcool, eram fisicamente ativos. Além de apresentarem menor grau de dependência, ausência de déficit cognitivo, ausência de sintomas depressivos e ausência de dificuldade na mobilidade. Conclusão Espera-se que a descrição das rotinas aplicadas possa auxiliar no desenvolvimento de novas pesquisas semelhantes em grupos de idosos. Assim, poderá ser acompanhado o processo de envelhecimento da população, seus fatores de risco e proteção.

Abstract Background Complementary exams may contribute to the understanding of the etiology of health problems in older adults. Objective To describe the operational aspects and protocols used to collect, analyze and storage biological materials, image exams and physical-functional capacity tests. Method This is a longitudinal and population-based study with 604 older adults (≥ 60 years) from EpiFloripa Ageing Study, in 2014. Data of biological material, body composition, bone densitometry, ultrasonography of the carotid artery intima average thickness, hand grip strength and physical activity were collected. Results The response rate was 50.4%. There was loss of follow-up in relation to age, cognitive status, and activities of daily living. The individuals who performed the tests were younger, worked by the time of the interview, ingested alcohol and were physically active. Also, they were less dependent, absence of cognitive impairment, absence of depressive symptoms and absence of difficulty in mobility. Conclusion It is expected that the description of the applied routines may help in the development of new similar research in the older adult population. Thus, the aging process of the population, its risk and protection factors can be followed.

Violência sexual contra crianças: autores, vítimas e consequências / Sexual violence against children: authors, victims and consequences

Resumo O objetivo deste estudo foi identificar características do abuso sexual contra crianças, como perfil da vítima, do autor da agressão e fatores associados, notificadas em um serviço de referência, utilizando o Sistema de Informação de Agravos de Notificação, em todos os casos suspeitos ou confirmados de abuso sexual infantil, de 2008 a 2014, em Florianópolis/SC. As variáveis foram: características da vítima, do agressor, da ocorrência, tipologia da violência, consequências, encaminhamentos e procedimentos realizados. Variáveis categóricas são apresentadas em prevalências e intervalos de confiança de 95%. Houve 489 notificações, predominando vítimas do sexo feminino, maior recorrência no masculino e ocorrendo em residências. Estupro foi duas vezes mais frequente no sexo feminino e em mais da metade dos casos o autor era homem conhecido da vítima. Doze vítimas contraíram infecções sexualmente transmissíveis, houve seis gestações, cinco delas interrompidas legalmente. Mesmo sendo inédito para a região estudada, se observou características semelhantes às encontradas em outros estudos brasileiros, mostrando ser possível ações coordenadas nacionalmente para prevenir esse agravo.

Abstract The scope of this study was to identify the characteristics of sexual abuse against children including the profiles of the victims and the perpetrators, and associated factors notified in a health service of reference with the database of the Brazilian Case Registry Database, in a city in the south of Brazil. Categorical variables are presented in prevalence with 95% confidence intervals. There were 489 notifications from 2008 to 2014 of confirmed or suspected child sexual abuse. The majority was related to female victims, but the repeated abuse was reported mainly with male victims. In most cases, the abuse took place at the victims' or perpetrators' homes and the main perpetrators of abuse were male and acquainted with the victims. Twelve victims have contracted sexually transmitted infections; pregnancies were six, five of them legally terminated. This study highlights that the child sexual abuse profiles were similar in almost all of Brazilian regions, showing that it is possible to have a coordinated national action to prevent this offence.

Parto normal ou cesárea: opinião de estudantes de medicina do sul do Brasil / Vaginal birth or cesarean: choices among medical students at universities in Southern Brazil

Objetivo: Identificar a opinião sobre via de parto entre estudantes de medicina de duas faculdades. Métodos: Estudo quantitativo transversal, com aplicação dequestionário em alunos de medicina de todos os anos em uma universidade federal e outra privada em Santa Catarina. Foram analisadas a via de parto que o res­pondente considerava com "menos riscos e mais benefícios" em gestação sem complicações, e via de parto que desejava para o nascimento de seus filhos (analisados fatores associados, como preferir cesariana).Para os alunos cursando o internato, questionou-se o momento em que "formou" ou "mudou" sua opinião. Resulta­dos: Dos 920 estudantes respondentes, a maioria considerou que parto vaginal é a via de menor risco (96% na faculdade pública,77% na privada).A preferência por cesariana para si mesmo foi de 20% de estudantes da escola pública e 55% dos alunos da escola privada (p< 0,001). Variáveis associadas com preferir cesariana para si mesmo foram "estudar em faculdade privada" (OR 4,9,IC 3,62-6,04) e "ter nascido de cesariana" (OR 2,29 IC 1,69-3,12). Durante o curso, referiram ter formado e/ou modificado sua opinião,38%dos estudantes sobre via de parto mais segura e 36% sobre via de parto preferencial. Conclusão: Estudantes de medicina reconhecem que o parto normal é mais seguro, mas 20% dos que frequentam a faculdade pública e 55% da faculdade privada preferem cesariana para o nascimento de seus filhos. Estas opiniões são modeladas durante ocurso e sofrem influência da via de nascimento do estudante e da faculdade aonde estudam.(AU)

Objective: To identify personal opinion on mode of delivery among medical students from two different universities. Methods: A quantitative cross-sectíonal study was carried out through a questionnaire applied at any year medical students from two different universities in Santa Catarina State (one public, one private). Mode of delivery that respondents considered "less risky and more beneficial" for low risk pregnant wom­en, and personal choice on mode of delivery for their own children were the key questions. Factors associ­ated with preferring cesarean section were analyzed. Students attending internship were asked about the moment they "formed" or "changed" opinion on the subject. Results: Of the 920 student respondents, the majority considered that vaginal delivery is the lowest risk route (96% in publíc college,77% in private).The caesarean preference for themselves was 20%for public school students, and 55% for private school students (p <0.001).Variables associated with preferring cesarean section for oneself were "studying in private college• (OR 4.9,CI 3.62-6.04) and "having been bornthrough cesarean"(OR 2.29 CI 1.69-3.12).Along graduation, having formed and/or modified opinion was reported by 38% of students about the safest delivery route, and 36% about preferred delivery route. Conclusion: Despite knowledge about the safety of normal childbirth, 20% of medical students attending public school and 55% of private school prefer cesarean for the birth of their children. The opinions are modeled during medical course,and influenced bythe student's own birth path and which university they attend.(AU)